单侧双通道内镜下腰椎融合术治疗腰椎退行性疾病的初步研究

Preliminary study of unilateral biportal endoscopic lumbar interbody fusion for the treatment of degenerative spinal disease

中文关键词:  内镜  腰椎融合术  腰椎退行性疾病

英文关键词:Endoscope  Lumbar interbody fusion  Degenerative spinal disease

中文摘要:

  【摘要】 目的：探讨单侧双通道内镜下腰椎融合术（unilateral biportal endoscopic lumbar interbody fusion，ULIF）治疗单节段腰椎退行性疾病的临床疗效。方法：回顾性分析2018年8月~2020年5月收治的76例单节段腰椎退行性疾病患者，其中ULIF治疗35例（ULIF组），微创经椎间孔入路腰椎融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗41例（MIS-TLIF组）。其中ULIF组男16例，女19例，平均年龄50.94±12.12岁；MIS-TLIF组男19例，女22例，平均年龄53.44±14.37岁。记录并对比两组患者的手术时间、术中出血量、术后住院时间、并发症，术前、术后2周、术后3个月、末次随访时腰痛及腿痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI），以及末次随访时融合率和改良Macnab评分。结果：所有患者均顺利完成手术。与MIS-TLIF组相比，ULIF组术中出血少（52.03±11.48ml vs 134.46±18.63ml，P＜0.05），术后住院时间短（8.43±1.88d vs 9.98±1.96d，P＜0.05）。两组患者术后VAS评分及ODI较术前均明显下降，术后2周ULIF组腰痛VAS评分为3.06±1.41分，显著低于MIS-TLIF组的4.10±1.64分，且术后2周ULIF组ODI为（32.20±4.32）% ，显著低于MIS-TLIF组的（37.11±4.72）%，差异有统计学意义（P＜0.05）。末次随访时ULIF组融合率88.6%，MIS-TLIF组融合率为90.2%，两组差异无统计学意义（P>0.05）。末次随访时ULIF组改良MacNab标准优良率91.4%（32/35），MIS-TLIF组为87.8%（36/41），两组差异无统计学意义（P>0.05）。结论：相较于MIS-TLIF，ULIF治疗腰椎退行性疾病具有术中出血量少、术后早期腰痛轻、术后住院时间短、早期功能恢复快的优点。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion(ULIF) in the treatment of single-segment lumbar degenerative diseases. Methods: Retrospective analysis of 76 patients with single-segment lumbar degenerative disease admitted from August 2018 to May 2020. Among them, 35 cases were treated by ULIF(ULIF group) and 41 cases were treated by minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)(MIS-TLIF group). There were 16 males and 19 females in the ULIF group, with a mean age of 50.94±12.12 years; there were 19 males and 22 females in the MIS-TLIF group, with a mean age of 53.44±14.37 years. The operative time, intraoperative bleeding, postoperative hospital stay, complications were compared between the two groups. The visual analogue scale(VAS) and Oswestry disability index(ODI) of low back pain and leg pain before surgery, 2 weeks after surgery, 3 months after surgery, and at the final follow-up were measured, as well as fusion rate and modified Macnab criteria at the final follow-up. Results: All patients completed the surgery successfully. Compared with the MIS-TLIF group, the ULIF group had less intraoperative bleeding(52.03±11.48ml vs 134.46±18.63ml, P＜0.05) and a shorter postoperative hospital stay(8.43±1.88d vs 9.98±1.96d, P＜0.05). In both groups, VAS score and ODI decreased significantly after surgery compared with those before surgery, and the VAS score of low back pain in the ULIF group at 2 weeks postoperatively was 3.06±1.41, which was significantly lower than that of the MIS-TLIF group(4.10±1.64), and the ODI of the ULIF group at 2 weeks postoperatively was(32.20±4.32)%, which was significantly lower than that of the MIS-TLIF group(37.11±4.72)%, and the difference was statistically significant(P＜0.05). The fusion rate at the final follow-up was 88.6% in the ULIF group and 90.2% in the MIS-TLIF group, with no statistically significant difference between the two groups(P>0.05). The excellent rate of modified MacNab criteria at the final follow-up was 91.4%(32/35) in the ULIF group and 87.8%(36/41) in the MIS-TLIF group, with no significant difference between the two groups(P>0.05). Conclusions: Compared with MIS-TLIF, ULIF has the advantages of less intraoperative bleeding, less early postoperative back pain, shorter postoperative hospital stay and faster early functional recovery in the treatment of lumbar degenerative disease.